The hidden battlefield: platelet function in the wake of severe trauma

Trauma contributes significantly to the global burden of suffering and death, and interrupts the complex balance between hemostasis and the immune system; platelets are key in integrating hemostatic and immune functions. This review will provide an overview of how different types of traumatic injury including traumatic brain injury, hemorrhagic shock, and burns impact platelet function through both separate and interconnected mechanistic pathways. Moreover, this review will examine in detail the multiple manifestations of trauma-induced platelet dysfunction, including but not limited to impairments in platelet activation, adhesion, aggregation and degregulation of granule secretion patterns. In addition, this review will describe how these platelet defects alter the dual roles of platelets as regulators of immunothrombosis and systemic inflammation. At a cellular level, separate types of trauma converge on shared molecular signaling pathways while utilizing different pathophysiological pathways to produce a complex network of regulations that control how platelets function. The purpose of this review is to present a comprehensive synthesis of current literature to provide a more complete overview of the mechanisms involved with trauma-related platelet abnormalities and to provide a framework for developing platelet-targeted therapies in the future.